ASAP-IT Program T-Number 14ATS

Contract No.______

Request Tracking No.______

CERTIFICATION COVER SHEET

Instructions:

1.  Complete this form in conjunction with any work order processed under the State of Minnesota’s ASAP-IT Program.

2.  This Certification Cover Sheet must be completed and signed by the agency before executing the corresponding work as the certifications made are required under Minnesota Statutes, 16C.08, subdivisions 2 and 3.

3.  Submit this Work Order Cover Sheet along with an electronic copy of the fully executed work order to .

Agency: / MN.IT @ (if applicable):
Division: / Name of Contractor & Resource:
Category: / Source of Funds (State/Federal):
Estimated Contract Value (original contract period): $ / Estimated Contract Value (including extension options): $
Original Contract Period:
From: To: / With option to extend ____ add’l ___ yr. periods

Agency Certifications. Pursuant to Minn. Stat. 16C.08, I certify:

1.  No state employee is (a) able and (b) available to perform the services called for by the contract.

How did you reach this conclusion:

2.  The normal competitive bidding mechanisms (low bid) will not provide for adequate performance of the service.

3.  Reasonable efforts have been made to publicize the availability of the master contract to the public.

4.  The agency will develop and implement a written plan providing for the assignment of specific agency personnel to manage the work order contract, including a monitoring and liaison function, the periodic review of interim reports or other indications of past performance, and the ultimate utilization of the final product of the services. The following person(s) has/have been assigned to manage the contract as well as monitor and act as liaison for the contract ______at ______(telephone number).

5.  No one in or on behalf of the agency will authorize the contractor to begin work before the work order contract is fully executed unless an exception has been granted by the Commissioner of Administration under Minn. Stat. §16C.05, subd. 2a and funds are fully encumbered.

6.  The work order contract will not establish an employer-employee relationship between the state or the agency and any person performing under the work order contract.

7.  In the event the results of the work order contract will be carried out or continued by state employees upon completion of the work order contract, the agency will require the contractor to include state employees in development and training, to the extent necessary to ensure that after completion of the contract, state employees can perform any ongoing work related to the same function.

8.  No current state employee will engage in the performance of the work order contract.

9.  Reasonable efforts will be made to avoid conflicts of interest throughout the selection and performance of this work order contract. All potential or actual conflicts of interest will be reported to MMD.

10.  The agency will not contract out its previously eliminated jobs for four years without first considering the same former employees who are on the seniority unit layoff list who meet the minimum qualifications determined by the agency. The seniority unit layoff list was reviewed on ______(date).

Agency signature (required)

Authorized Certification Officer authorized to sign contracts: / Date:

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ASAP-IT Certification Cover Sheet

Rev. 2/16